Provider Demographics
NPI:1366493850
Name:PENATE, FELIX G (MD)
Entity Type:Individual
Prefix:
First Name:FELIX
Middle Name:G
Last Name:PENATE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6450 W 21ST CT STE 200
Mailing Address - Street 2:
Mailing Address - City:HIALEAH
Mailing Address - State:FL
Mailing Address - Zip Code:33016-3942
Mailing Address - Country:US
Mailing Address - Phone:305-698-0806
Mailing Address - Fax:305-698-2325
Practice Address - Street 1:14150 SW 119TH AVE STE 102
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33186-6012
Practice Address - Country:US
Practice Address - Phone:786-709-9362
Practice Address - Fax:786-709-9364
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME87037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL263584400Medicaid
FL263584400Medicaid
FLE7033DMedicare PIN